Global forecast of antimicrobial resistance in invasive isolates of Escherichia coli and Klebsiella pneumoniae.
Global forecast of antimicrobial resistance in invasive isolates of Escherichia coli and Klebsiella pneumoniae.
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DOI：
10.1016/j.ijid.2018.01.011
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Laxminarayan R
中科院分区：
文献类型：
--
作者：
Alvarez-Uria G;Gandra S;Mandal S;Laxminarayan R
我们的目的是估计大肠杆菌和肺炎克雷伯菌侵入性分离株的抗菌药物耐药性的全球趋势。到 2030 年，超过一半的大肠杆菌和肺炎克雷伯菌侵袭性分离株可能对第三代头孢菌素产生耐药性。肺炎克雷伯菌侵袭性分离株中的碳青霉烯类耐药性正在迅速增加。预测大肠杆菌和肺炎克雷伯菌未来的抗菌素耐药性 (AMR)。混合线性模型是根据抵抗地图数据库中具有 AMR 数据的国家样本构建的。使用逆概率加权方法来解释没有抗菌药物耐药性数据的国家。 2015 年，第三代头孢菌素耐药 (3GCR) 大肠杆菌的 AMR 估计患病率为 64.5%（95% 置信区间 (CI) 42–87%），碳青霉烯类耐药 (CR) 大肠杆菌为 5.8%（95% CI 1.8–9.7%），66.9%（95% CI） 3GCR 肺炎克雷伯菌为 47.1–86.8%)，CR 肺炎克雷伯菌为 23.4% (95% CI 7.4–39.4%)。预计到 2030 年，3GCR 大肠杆菌的 AMR 患病率为 77%（95% CI 55-99.1%），CR 大肠杆菌为 11.8%（95% CI 3.7-19.9%），3GCR 肺炎克雷伯菌为 58.2%（95% CI 50.2-66.1%），52.8%（95% CI 16.3–89.3%) 对于 CR 肺炎克雷伯菌。这些模型表明，到 2030 年，第三代头孢菌素和碳青霉烯类药物可能对世界大部分地区相当大比例的大肠杆菌和肺炎克雷伯菌感染无效，因此需要加强管理工作，并优先研究和开发针对耐药肠杆菌科的新型抗生素。
We aimed to estimate global trends of antimicrobial resistance of E. coli and K. pneumoniae invasive isolates. By 2030, over half of E. coli and K. pneumoniae invasive isolates could become resistant to third generation cephalosporins. Carbapenem resistance is increasing rapidly among K. pneumoniae invasive isolates. To project future antimicrobial resistance (AMR) in Escherichia coli and Klebsiella pneumoniae. Mixed linear models were constructed from a sample of countries with AMR data in the ResistanceMap database. Inverse probability weighting methods were used to account for countries without AMR data. The estimated prevalence of AMR in 2015 was 64.5% (95% confidence interval (CI) 42–87%) for third-generation cephalosporin-resistant (3GCR) Escherichia coli, 5.8% (95% CI 1.8–9.7%) for carbapenem-resistant (CR) E. coli, 66.9% (95% CI 47.1–86.8%) for 3GCR Klebsiella pneumoniae, and 23.4% (95% CI 7.4–39.4%) for CR K. pneumoniae. The projected AMR prevalence in 2030 was 77% (95% CI 55–99.1%) for 3GCR E. coli, 11.8% (95% CI 3.7–19.9%) for CR E. coli, 58.2% (95% CI 50.2–66.1%) for 3GCR K. pneumoniae, and 52.8% (95% CI 16.3–89.3%) for CR K. pneumoniae. The models suggest that third-generation cephalosporins and carbapenems could be ineffective against a sizeable proportion of infections by E. coli and K. pneumoniae in most parts of the world by 2030, supporting both the need to enhance stewardship efforts and to prioritize research and development of new antibiotics for resistant Enterobacteriaceae.
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